Self-Care to Prevent Birth-Related UI in Diverse Women

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DESCRIPTION (provided by applicant): Despite compelling evidence that pelvic floor muscle training (PFMT) reduces childbearing women's risk of urinary incontinence (UI) by up to 39-59% 1;2;3, too few childbearing women adopt and sustain this practice. Recent review reaffirms PFMT as recommended practice during pregnancy/postpartum 4, but only 20-52% of childbearing women report its use 5;3;6. Moreover, virtually all previous trials of self-care to prevent UI have been with Caucasian women. Our RCT with older women testing the UI prevention efficacy of a combined PFMT and bladder training (BT) self-management program applied Bandura's 7 self-efficacy theory: the intervention was taught in an intensive class and demonstrated a two-fold preventive effect 8. Furthermore, adherence to PFMT was high (82% at 3 months post instruction) and sustained (68% at 12 months) 9. These results encourage us to extend our current study (NIH R01 NR07618, PI C. Sampselle) with this competing continuation. To assure adequate racial/ethnic representation, we will over sample African American and Hispanic women using community-based sites that serve diverse patients. Aim 1 will determine the efficacy of an intensive antenatal Bladder Health Class to prevent UI at 12 months postpartum in a diverse sample of African American, Caucasian, and Hispanic childbearing women. Aim 2 will examine the capacity of adherence to mediate the association of self-efficacy with UI incidence. Aim 3 will explore the attitudes and strategies among 3 racial/ethnic groups that facilitate or deter adherence. Aim 4 will explore the efficacy of the Bladder Health class at 3 years post index birth. To accomplish Aims 1 and 4, we will conduct a single-blind RCT following intention-to-treat assumptions taking race/ethnicity into account. To accomplish Aim 2, we will assess the role of adherence as a mediator of the relationship between self-efficacy and UI. If Aim 1 hypotheses are supported, an intensive Bladder Health Class could become the standard of care for maternity patients. Aim 2 & 3 results will provide insights re: the mediating role of adherence and about facilitators/barriers to self-management. Aim 4 results will yield much needed long term data regarding the potential benefit of these UI preventive self-care practices. Ultimately we intend to mount effectiveness RCT, which will be informed by the results of the study proposed here. Pelvic floor muscle training (Kegel Exercise) reduces urinary incontinence and is strongly recommended for pregnant and postpartum women, but very few do them. This study will test a combination of self-care that includes pelvic floor muscle training in a multicultural group of women who are pregnant with their first, second, or third child. In an earlier study this combination of self-care cut women's risk of incontinence in half one year later. If successful, an important new way to prevent urinary incontinence will be available for maternity patients.